Provider Demographics
NPI:1275822645
Name:GEORGIA MOUNTAINS COMMUNITY SERVICES
Entity Type:Organization
Organization Name:GEORGIA MOUNTAINS COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-513-5737
Mailing Address - Street 1:4331 THURMON TANNER RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2829
Mailing Address - Country:US
Mailing Address - Phone:678-513-5737
Mailing Address - Fax:678-513-5836
Practice Address - Street 1:2467 OLD CORNELIA HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-7853
Practice Address - Country:US
Practice Address - Phone:678-513-5737
Practice Address - Fax:678-513-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000600795ACMedicaid